Provider Demographics
NPI:1467608844
Name:CHANG, WAYNE H (MD,)
Entity Type:Individual
Prefix:
First Name:WAYNE
Middle Name:H
Last Name:CHANG
Suffix:
Gender:M
Credentials:MD,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1701 VIRGINIA RD
Mailing Address - Street 2:
Mailing Address - City:SAN MARINO
Mailing Address - State:CA
Mailing Address - Zip Code:91108-2515
Mailing Address - Country:US
Mailing Address - Phone:626-234-2025
Mailing Address - Fax:
Practice Address - Street 1:1701 VIRGINIA RD
Practice Address - Street 2:
Practice Address - City:SAN MARINO
Practice Address - State:CA
Practice Address - Zip Code:91108-2515
Practice Address - Country:US
Practice Address - Phone:626-234-2025
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-17
Last Update Date:2008-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA30102207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine